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Unit of Care
Mek Villafuerte-Solana,
MD, DPAFP
Aug. 11, 2009
DEFINITION OF
THE FAMILY
p Sociologic Viewpoint
n Enduring social form
in which a person is
incorporated
p Biologic Viewpoint
n Genetic transmission
unit
p Psychologic Viewpoint
n Matrix of personality
development and
the most intimate
emotional unit of
FAMILIES
COMPRISE
OF PEOPLE
WHO HAVE A
SHARED HISTORY
AND A
SHARED FUTURE
Characteristics of the
Filipino Family
CHARACTERISTICS OF THE
FILIPINO FAMILY
p Closely knit
p Bilaterally extended
p Strong family
orientation
p Authority based on
age/seniority
p Externally patriarchal,
internally matriarchal
p High value on education
of members
CHARACTERISTICS OF THE
FILIPINO FAMILY
p Predominantly
Catholic(80%
population)
p Child centered
p Average members is 5
p Environmental stresses:
economic, political,
urbanization &
industrialization,
health problems
p
THE FAMILY AS A VERY
SPECIAL UNIT
p Lifelong involvement
p Shared attributes
n Genetics – physical/psychological
n Developmental – shared home, lifestyle &
social activities
p Sense of belonging
n Security/defense against potentially hostile
environment
n Companionship
THE FAMILY AS A VERY
SPECIAL UNIT
p Societal expectations
n Sense of responsibility toward members and others
n Basis of affection/care
p Built-in problems
n Generation gap
n Dependence on members
n Emotional attachment/involvement
p The family endures in-spite of problems
n Resource utilization
n Authority
n Individual sense of responsibility
FAMILY STRENGTHS
p Ability to provide family’s
needs
n Physical – space
management, balanced
meals, general health
status
n Emotional – helping
members develop their
capacity for sensitivity
to each other’s needs
n Spiritual/Cultural –
sharing beliefs &
FAMILY STRENGTHS
p Child – rearing practices
and discipline
n Capacity of parents to
respect views on
child rearing
practices
n If a Single Parent, the
capacity of a single
parent to be
consistent and
effective in raising
children
FAMILY STRENGTHS
p Communication
n Ability to communicate and express
emotions verbally/non-verbally
p Support, Security & encouragement
n Capacity to provide with feelings of security
& encouragement
n Balance in pattern of family activities
FAMILY STRENGTHS
p Responsible Community Relationships
n Capacity to assume responsibility through
participation in social, cultural or
community activities
p Self-Help & accepting Help
n Ability to seek & accept help when they
need it
FAMILY STRENGTHS
p Flexibility of Family Functions & Roles
n Ability to “fill in” for one another during
times of illness/when needed
p Crisis as a means of Growth
n Ability to unite & become supportive during
crisis/traumatic experience
FAMILY AS A UNIT OF
CARE
p THE FAMILY AS THE SOCIAL CONTEXT
FOR HEALTH CARE
n Transmission of infectious/communicable
diseases
n Health behavior requirements in the unit
n Resource utilization/source of support
n Health and illness definitions
n Health decisions/approaches and strategies
FAMILY AS A UNIT OF
CARE
p THE PATIENT’S PROBLEM IS THE FAMILY’S
PROBLEM
n Doherty and McCubin, 1985: Important
ways in which the family plays a role in
the health of its members:
p health promotion/maintenance and
illness/injury prevention
p coping with stressful life events
appraisal
FAMILY STRUCTURE
p Nuclear
n Members: parents & dependent
children
n Occupying separate dwelling not
shared with members of the
family of origin of either
spouse.
n The household is economically
dependent, subsisting from the
occupational earnings of
husband/father
FAMILY STRUCTURE
p Extended Family
n Unilaterally extended
n Bilaterally extended
n Includes 3 generations; family centered;
lives together as a group & through its
kinship network provides support
functions to all members
FAMILY STRUCTURE
p Single-Parent Family
n Children < 17 yrs. old living in a family unit
with a single parent, another relative, or
non-relative
n May result from loss of spouse by death,
divorce, separation, desertion
n Out-of-wedlock birth of a child
n From an adoption
n One parent is working outside the
Philippines (ocw, dhws etc.)
FAMILY STRUCTURE
p Communal/Corporate Family
n Grouping of individuals formed for specific
ideological or societal purposes
n Considered as alternative lifestyle for people
who feel alienated from the
predominantly economically oriented
society
BASIC AREAS OF FAMILY
FUNCTION
p Biologic
n Reproduction
n Child rearing/caring
n Nutrition
n Health maintenance
n Recreation
p Economic
n Provision of financial resources
n Resources allocation
n Ensure financial security of member
BASIC AREAS OF FAMILY
FUNCTION
p Educational
n Teach skills, attitudes and skills relating to
other functions
p Psychologic/ Affection
n Promotes natural development of
personality
n Offer optimum psychological protection
n Promotes ability to form relationship with
people in family circle
p Socio-Cultural
n Socialization of children
n Promotion of status and legitimacy
ORDINAL POSITION
(DIFFERENCES IN BEHAVIOURS)
p First Born – generally persevering
n Serious
n More responsive to adults
n Achievement oriented
p Middle Child - optimistic
n Sociable
n Aggressive
n Competitive
n Occasionally manipulative
p Youngest - demanding
n Outgoing
n Occasionally narcissistic
n By nature are affectionate
FAMILY SOCIAL CLASS
PATTERNS
p Upper Class
n much more closely knit
n greater concern for maintaining for family
name & prestige
p Middle Class
n believes in hard-work, initiative,
independence, responsibility, economic
security & self improvement through
education
p Lower Class
n sees life as continual struggle for survival
n resigned to a life of frustration and defeat
FAMILY SET-UP
p Democratic
n Parents respect child’s decision/idea
n Understanding & permissiveness prevail
p Authoritarian
n Unquestioned obedience conformity to
Parental guidance
n Pattern of punishment than praise
n Patients with Low self-reliance
n Suspicious adults
n Stand poorly in stressful situation
n Become hostile with pain/discomfort
QUESTIONS?
Tools of Family
Assessment
Marikka Villafuerte-Solana, MD
San Beda College of Medicine
Objectives of the Session
p Learn to incorporate a family systems
approach to clinical practice
p Understand the different tools of family
assessment
p Apply/ use the tools of family assessment
in clinical practice
Family Systems Approach to
Patient Care
p Better health care results if family
relationships, social and cultural systems
are all considered
p Can facilitate a new level of
understanding of a patient’s problem
p Requires understanding the structure and
function of the family
Incorporating a
Family Systems
Approach into
Clinical Practice
STEP 1- Know the
Individuals/
Members of the Family
p Know the individuals in the family
p Obtain the following information
n Names of members
n Place of residence
n Specific roles in the family
n Stage of the family life cycle
n Significant dates in the family
(marriage, birth, death, etc)
STEP 1- Know the
Individuals/
Members of the Family
II
Lucil Hazel Salva
Joy Ayn Ivy
22 21 17
25 20 18
III
C C- cancer
MAE BRAYN T- tb
25
23 H- hepatitis
- HPN
Reid
1
May 19, 2003 A- asthma
SOLANA-VILLAFUERTE FAMILY
I
Graciano Remedios David Tess
82 65 58 55
II
Manding
Amy George Lydia Imelda Elizabeth Grace
Reggie Jhay Bhen
31 22 20
Victoria Nene Hearty Mandy
Julie Mien
28 28
III 4 4 6 Lester
Michael
Diabetes P P 3
II
Lucil Hazel Salva
Joy Ayn Ivy
22 21 17
25 20 18
III
C- cancer
MAE BRAYN T- tb
25
23 H- hepatitis
- HPN
Reid
1 A- asthma
May 19, 2003
THE FAMILY
MAP JOLENE Jun
MAE
Efron Rizza
Joy Lucil
Salva
Ayn
Hazel
Ivy
BRAYN
THE FAMILY
CIRCLE
p
p The Family Physician draws a large circle
on a piece of paper and instructs the
patient to draw small circles
representing himself and each
member of his family
THE FAMILY
CIRCLE
Reggie
Papa
Daday
Jhay
Bhen
Nanay
a m a
a rty Purs
M He Mek
Chai Thea Justin
Juni
THE FAMILY
APGAR
p Consists of five questions that assess
family function
p Rapid screening instrument for family
dysfunction
p Measures the individual’s level of
satisfaction about family relationship
THE FAMILY
APGAR
p Part I helps define degree of patient’s
satisfaction w/ family
p Part II delineates relationship w/ other
members, and identifies people who can
give assistance to the patient
p Scores of 8-10 points= highly functional
family
4-7= moderately dysfunctional
0-3= severely dysfunctional
THE FAMILY
APGAR
p Situations where the APGAR is needed
n When the family will be directly
involved in caring for the patient
n When treating a new patient, in order
to assess family function
n When treating a patient whose family is
in crisis
n When a patient’s behavior makes you
suspect a psychosocial problem due
to family dysfunction
THE FAMILY
APGAR
SCREE
M
p Shows the capacity of the family to
participate in the provision of health care
or to cope with crisis
p Each factor can be considered as a
resource or a pathology
DRAW A FAMILY
TEST
p Provides clues on the individual members
of the family w/ regards their
personalities
p Members of the family find the opportunity
for self-expression, thus revealing and
relieving innate difficulties w/in the
family systems
LIFE LINE/LIFE
CHART
p The individual’s experiences with health
and sickness are connected with his
personal life
p If life events and clinical events are put
side by side accdg to dates of
occurrence, the correlation between the
two can be shown
LIFE LINE/LIFE
CHART Mae was born to Jolene and
May,1980
Ernesto
Childhood
days
Happy days
College
Years